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Anterior blepharitis:
• Cleaning with a cotton bud wetted with bicarbonate or diluted baby
shampoo to remove squamous debris from lash line .
• Topical steroid: used infrequently.
• Topical +/- systemic antibiotic in staphylococcal lid disease .
Posterior blepharitis:
• Hot compressors and lid massage.
• Oral tetracycline.
• Artificial tears to prevent dryness
LID LUMPS
Chalazion
-It is a granuloma within the tarsal plate caused by obstructed
meibomian gland.
-Painless.
-Symptoms are unsightly lid swelling which resolve within six months if
the lesion persist we remove it surgically
Internal hordeolum
an abscess in
meibomian gland.
-Painful.
-May respond to
topical antibiotics
but incision may
be necessary.
External Hordeolum (Stye)
- It is an abscess in
eyelash follicle.
painful
-Most cases are self
limiting .
-Treatment requires
the removal of the
associated eyelash
and application of
hot compresses.
Molluscum Contagiosum
-Is a viral infection of
the skin or the mucous
membranes, caused by pox
virus.
- Usually
associated with
hyperlipidemia .
- Removed for
cosmetic reasons.
Itdoes not cause
vision problem
Eyelid neoplasm
1. Basal cell carcinoma:
- the most common eyelid malignancy
- lower eyelid margin ( 50-60 %)
- risk: fair-skinned or light colour of an eye
middle age
sun exposure
smoking
- firm, raised, pearly nodule with central ulceration
- Management: incisional biopsy: confirm diagnosis
excisional biopsy
Basal Cell
Squamous Cell
• 40x less common than
BCC
• More aggressive
– perineural invasion
• Most arise from pre-
existing lesions
• Variable presentation
Sebaceous adenocarcinoma
• Highly malignant
• 2x more common in upper lid
• carcinoma of seabaceous glands
• nodule lesion and later causes loss
of eyelashes
• women > 50 years
• upper lid ( more meibomian glands )
• DDx. chalazion, chronic blepharitis,
BCC, SCC
• Management: - full-thickness punch
biopsy of the tarsus
• wide surgical excision
•
Malignant melanoma:
- risk: sunlight exposure, genetic, environmental mutagen
- rare
- Management: wide surgical excision
ABNORMALITIES OF LID POSITION
ptosis
Brow ptosis
Marcus Gunn Jaw-Winking syndrome
• Location of lesion:
– Supranuclear, brain
stem, peripheral
• Cause of paralysis:
– Bell’s
– Infection
– Infarct
– Demyelination
– Neoplasm
– Trauma
– Miscellaneous
Lachrymal system disorders
Lacrimal system
1. Congenital nasolacrimal obstruction
- membraneous block of the valve of Hasner
- 50% of newborn
- spontaneously resolved 4-6 weeks after birth
- Management: - conservative treatment with topical antibiotic
- Crigler massage
- probing ( after 6 months )
2. Acquire nasolacrimal obstruction
- involutional stenosis
- women:men = 2:1
- epiphora
- Management: Dacryocystorhinostomy (DCR)
Lacrimal system
3. Dacryocystitis:
- cause : nasolacrimal duct obstruction
- clinical finding: - edema and erythema below the medial
canthal tendon with distension of lacrimal
sac
- Management: - Topical and oral antibiotic ( gram+ bacteria)
- Dacryocystorhinostomy
Dacryocystitis
Disorders of ORBIT
Evaluation
• 7 P’s
– Pain
– Proptosis
– Progression
– Palpation
– Pulsation
– Periorbital changes
– Past medical history
Imaging options
• Plain films
• CT scan
• MRI
• Ultrasound
Plain films
• Quick
• R/o foreign bodies
• Infrequently used Caldwell’s view
Pleomorphic adenoma
VASCULAR ORBITAL DISORDERS
2. Carotid-cavernous fistula
• Direct
• Indirect
Orbital venous anomalies (varices)
Eyelid varices
Causes
• Head trauma - most common
• Spontaneous rupture - in hypertensive females
Causes
• Congenital malformations
• Spontaneous rupture